Factors Influencing Medical Prescribers' Acceptance of Pharmacists’ Recommendations in Non-hospitalized Older Adults: A Systematic Review and Meta-Analysis

Abstract

Objectives

To investigate the rate of, and factors affecting, acceptance of pharmacists’ recommendations by medical prescribers following medication reviews conducted in non-hospitalized older adults.

Design

A systematic review and meta-analysis with meta-regression.

Setting and Participants

Older adults (mean aged ≥55 years) residing in the community or in aged care facilities (ie, non-hospitalized) who had received an individualized medication review by a pharmacist.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 databases (MEDLINE, Embase, and Web of Science) from 2000 until May 2024, and included studies that reported the acceptance rates of pharmacists’ recommendations by prescribers, either by recommendation type (eg, initiation, cessation, dose change) or the reason for the recommendation (eg, drug-related problem identified). JBI tools were used to assess the methodological quality, and a meta-analysis with meta-regression was performed.

Results

There were 21 studies included in the review: 13 studies in the community setting, and 8 in aged care facilities. The acceptance rates of the pharmacists’ recommendations ranged from 42% to 93%, and the implementation rates ranged from 27% to 88%. The setting where the pharmacist conducted the review was found to be a significant determinant in the acceptance of recommendations in the meta-regression model (P = .021), with the highest acceptance and implementation rates reported when pharmacists were integrated into general medical practices (79%; 95% CI, 52%–97%).

Conclusions and Implications

The acceptance of pharmacists’ recommendations following the conduct of medication reviews was highly variable. Multiple factors appear to influence acceptance rates, particularly the setting where the pharmacist conducted the review and the level of collaboration between the pharmacist and prescriber. Future research should explore targeted strategies to improve collaboration and communication between pharmacists and prescribers, such as the integration of pharmacists into general medical practices and aged care facilities.